In-Depth Interviews: Techniques and Best Practices
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Slides from a 2-hour facilitated workshop presented at the Alliance for Continuing Education in the Health Professions
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In-Depth Interviews: Techniques and Best Practices
- 1. In-Depth Interviews: Techniques and Best Practices A workshop in conjunction with the ACEHP Annual Conference Wendy Turell, DrPH, CCMEP President Contextive Research LLC wendy@contextiveresearch.com Alexandra Howson MA, PhD, CCMEP Owner Thistle Editorial, LLC alexhowson@thistleeditorial.com Friday, January 17, 2014 4:15pm-6:15pm
- 2. Overview Learning Objectives: After participating, learners will be able to: • Develop, pilot, and administer an interview guide for an IDI series • Demonstrate optimal interviewer skills and techniques to encourage full feedback from interviewees
- 5. Naturalistic/inte rpret-ative approach Focus on how people perceive their worlds and interpret experience
- 6. Data: What vs Why Quantitative Data: A 37% drop-off was observed in adherence to post surgery medication regimens Qualitative Data “After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.”
- 7. Relevance to CEHP Needs assessment Formative evaluation Outcomes evaluation
- 8. Why Interview? • It‟s good to talk o Provides depth + context to other data • Lopsided conversation • Relies on interaction
- 9. What Defines an Interview? A tool to direct or guide a conversation between 2 or more people towards a particular outcome. Frey and Oishi (1995:01) define Interview as “a purposeful conversation in which one person asks prepared questions (interviewer) and another answers them (respondent).” Examples: • Journalistic • Clinical • Research • Occupational
- 10. Activity 1: Core Components of Interviews • What went well in this interview? • What did not work?
- 11. Debrief
- 13. Components of an Interview • Opening/building rapport • Language (word choices) and tone • Body language • Empathy • Questions that will elicit deep response
- 14. The Interview Guide • Keeps you on track • Ensures material/research question coverage • Establishes sequence
- 15. Question Order Small chat/ ice-breaker conversation more serious sensitive
- 17. Question Types • Open ended, neutral, sensitive, clear to respondent 1. Main questions 2. Probes 3. Various follow up questions Patton, MQ. How to use qualitative methods in evaluation. London: Sage, 1987.
- 18. Main/Introducing • “Tell me about….?” • “Do you remember an occasion when…?” • “What happened when you...?”
- 19. Prompts + Probes • Extensions of main question • Aimed to encourage respondents to share more information and touch on areas they did not initially address • May reflect statements or use vocabulary of respondent “You mention patients come into visits with opinions from these ads. How does that impact the interaction?” “Could you say something more about that?” “Can you give a more detailed description of what happened?” “Do you have further examples of this?”
- 20. Specifying • “What did you think at that point?” • “What did you actually do when you realized he had this side effect?” • “How did your colleagues react when you started the new program?”
- 21. Direct/Indirect Direct Indirect “In what ways do you implement these guidelines post diagnosis? “ “How do you believe other physicians view these guidelines?” “Describe ways in which you support your patients‟ adherence efforts” “What do you think are the reasons behind your patients‟ lack of adherence?” AH: I made the examples more CME specific. Do these still fit as good examples of direct/indirect questions in your opinion?
- 22. Interpreting “When you use the term „uncontrolled‟ disease, are you referring mainly to A1Cs?” “So do you mean that the patients have literacy challenges?” “Is it correct to say that you are typically unable to chose your ideal treatment due to these barriers?” “Does the expression „trying to keep up‟ describe what you have just expressed?”
- 23. More about Questions • • • • • • Use vocabulary of respondent Appropriate tone (make sure order/sequence is in deck somewhere) What open ended q looks like Language that may invoke defensiveness Leading questions
- 24. Time to Craft Some Questions
- 25. Activity 2: Your Mission… • As CME Director of Main Street Community Hospital, you and your team have been asked to interview 20 recently discharged patients who received joint replacement surgery. The hospital administration would like to learn about patient satisfaction during their stay as part of an education program designed to reduce readmission rates. • Develop 5-7 questions that will help hospital leadership better understand more about “patient satisfaction”.
- 26. Activity Debrief
- 29. WHAT ARE YOU REALLY SAYING?
- 31. Online: Virtual Interview Room Optional Webcamenabled images Text based chat & audio capable
- 32. Skype video call
- 33. Activity 3: Revisit Your Questions • As CME Director of Main Street Community Hospital, you and your team have been asked to interview 20 recently discharged patients who received joint replacement surgery. The hospital administration would like to learn about patient satisfaction during their stay as part of an education program designed to reduce readmission rates. • Develop 5-7 questions that will help hospital leadership better understand more about “patient satisfaction”.
- 35. Interviewer Behavior • Active Listening – Be „in the moment‟ o Patience, okay with silence • Encourage respondent o Give appropriate verbal and non-verbal feedback • Stay neutral o Avoid presenting your perspective (bias interview) o Avoid counseling, teaching • Reflecting o Paraphrase/reflect back
- 36. Capturing Information o Audio Recording • Digital Recorder o Conference lines o Phone apps (e.g., italk) • Video recording • Pen and paper notetaking
- 37. Activity 4: Interviewing with partners • 1:1 pairing • Practice using revised questions • Chose one partner to share information on experience REMEMBER: Active Listening Reflect back to respondent Stay neutral
- 38. Interview Disadvantages • Time intensive • Bias (researcher + interviewee) • Skill requires practice! • Lack of generalization
- 39. Subjects • Recruitment • Screening o participants/inclusion criterion • Subject preparation o What to expect o Institutional Review Boards (IRBs) o Informed Consent
- 40. Questions?
- 41. Follow-up Questions? Contact Us Wendy Turell, DrPH, CCMEP President Contextive Research LLC wendy@contextiveresearch.com Alexandra Howson MA, PhD, CCMEP Owner Thistle Editorial, LLC alexhowson@thistleeditorial.com
- 42. Resources
- 43. Software Resources: Coding & Organization • Free (QDA Miner Lite) o http://provalisresearch.com/products/qualitative-data-analysis-software/freeware/ • Low Cost: dedoose ($10 per month) o http://www.dedoose.com/ • Bells and Whistles software: Nvivo or Atlas Ti o http://www.qsrinternational.com/products_nvivo.aspx o http://www.atlasti.com/index.html
- 44. Resources Cont. • Hopkins Open Coursework: http://ocw.jhsph.edu/ • Qualitative course materials: o http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/qualitativedataanalysis/cou rsePage/index/ • Online Qual. Textbook: http://onlineqda.hud.ac.uk/Introduction/index.php
- 45. Resources Cont. • Cater JK. SKYPE: a cost-effective method for qualitative research. Rehab, Counselors + Educators Journal. 20011;4: • Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med. 2008;6:331-339. • Curry L, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009. 119:1442-1452.
- 46. Appendix
- 47. Conversation vs. Interview Conversation Interview Respondent Friend/Acquaintan ce Recruited respondent Who provides Questions/Answe rs Generally equal Lopsided questions/answers among participants Tone Share true feelings, Maintain objective tone, reactions to what non judgmental, non you hear reactionary Focus Typical focus on immediate outcome (e.g.: how was the game?) Process, cause/consequences, context, search for patterns Depth Most often a range of issues, not always deep Narrow range of issues, greater depth
- 48. Qualitative Research Quantitative Research Type of Questions Probing “below the surface”; immediate follow up & adjustment Limited probing; predetermined questions NOT adjusted Sample Size Small Any size including large Information per respondent Much Administration Requires skilled researcher Type of Analysis Follows structured steps; subjective and Statistical; objective interpretative Type of Research Exploratory, descriptive Varies; Limited to answer choices Fewer specialist skills required Descriptive or Causal
- 50. White Board Exercise example SGLT2 inhibitors DPP4 Inhibitors Which drug class do you prefer to use in patients who fail on oral monotherapy?
Notes de l'éditeur
- Qualitative interviews basedon assumption that human behavior is framed by social and cultural context, and is influenced by beliefs, attitudes and values.[Goodson 2011] These characteristics make qualitative methodology an especially good fit for settings based interventions designed to foster changes in clinician behavior and practice, such as CME interventions in healthcare organizations, because they lend themselves to in-depth exploration of the context of intervention and recognize the complexity of change. Example of how interview data can flesh out survey dataInterviewsfocus on generating Depth vs. breadthInstead of counting or identifying statistics….Understanding situations, individuals, groups, phenomena, relationships, environments, etc.
- Qualitative IDIs require specific preparatory and in-the-moment skills to enable full subject response. Whether you are interested in conducting telephonic, online, or live interviews with healthcare team members or patients, similar steps will help you confidently unearth answers to the research questions you hold.
- Talk and conservational exchange is at the heart of much day to day communication. Conversation is a cultural tool with reasonably consistent rules of give and take that we learn from a young age. Talk/conversation allows us to share stories about our concerns and experiences and interact with each other to create social connection – and that’s what interviews capitalize on, that people have stories to tell and that we are wired to share them with others. In contrast to survey and other standardized research instruments, interview require a deep, focused, and sustained degree of interaction between interview and interviewee. Asking expansive, exploratory questions allow unexpected data to materializeBut an interview is also a lopsided conversation in that interviewer asks most of the questions; respondent gives MOST of the answers- not really a normal conversation.
- So what is an interview? Examples we are all familiar withRegardless of kind of interview, we contend that there are certain core element of interviews that contribute to their effectiveness and skills that support successful interview outcomes – i.e. that you get the information that you are looking for in way that has integrity (i.e. doesn’t offend participants or breach ethics) and is trustworthy (i.e. that the interview method/approach that is used can be relied upon to generate results that can be verified).Let’s explore the idea of core attributes a bit more by reviewing an example of a journalistic interview with a veteran British journalist interviewing Meg Ryan. Ask participants to review clip (2 mins 48 secs) and note what works in this interview, and what doesn’t, what interviewer does that seems effective, and what does not seem effective. Once they have reviewed the clip and made notes, spend a few minutes sharing observations in pairs or small groups.
- Group viewing of video clip with Meg Ryan (<3 mins)Solo/pair/share activityEach participant reviews and makes notesPairs with 1 other personShares observations
- Debrief: ask for feedback. As people report, add observations to flipchart. After feedback is exhausted, share the next slide. Feedback might include the following:Opening/building rapportLanguage (word choices) and toneBody languageEmpathyOpen-ended questions
- Don’t get into details about thisFlagging this upThese are all items important 2 ensure successful interviewAll important, we’re going to start with questions
- Purpose of guide during interviewThis is your question map but also has other functions.Important to have a script to guide opening, direction and closing of the interview, helps you to remember the housekeeping information you might need to share at the beginning (remind participant what focus of research is, ensure consent has been collected etc, alleviate concerns about confidentiality and depending on nature of setting, time, focus etc use social conversation as a way to break the ice and begin to build some rapport). Helps you to map out sequence: begin with the basics and move from easy to challenging – helps to establish trust, warm up the interviewee – your research focus/literature will help you define what background information to collect (eg when we are doing in-practice research, we often begin by asking interviewees to describe their practice (sometimes this is structured, very focused, and sometimes more open to allow interviewees to set the agenda a little more)Important to have a guide whether you follow it closely or not (depending on level of structure) to help you stay in control of the interview – remember, it’s a lopsided conversation. This is especially important when there are power imbalances in interviewing, and we’ll touch on these in a little bit.How to use during interview (varied based on you’re approach- level of structure)
- What open ended q looks likeLanguage that may invoke defensivenessQ writing, q order
- Once you’ve moved beyond the basic question…Following slides adapted from Kvale 1995 – we can add examples from our experience of projectsAlign with research questions/goalsExample:Please explain your satisfaction with the CME Activity entitled “New Advances in Treatment of the Common Cold”?
- Projective – we can change the examples here to align with audience
- Acts as acknowledgement and also helps to build empathy + respect – shows you are listening actively
- Group activity 2: Develop mock interview guide with participants, work in small groupsPatient experience during their hospital stay: what happened, which personnel cared for them, how would they characterize quality care…?Patient satisfaction with their healthcare experience: highs and lowsPatient perspective on healthcare quality during their stay: what needs to be improved, did stay meet their expectations…
- Make sure you build in different types of questions as we’ve discussed to get as full responses as possible
- Write on post it notes, put on the wall, learners walk around and view each others questionsAsk group to share their q’s and provide rationale.Write on white board/flip chart, use this info to debrief on q writingCategories of questions walk around idea?
- Pause here to ensure understanding, leave room for questions and commentsDifferent formats to conduct interviews which implications for interviewer presence and nature of interpersonal exchange, which can have a bearing on the kind and quality of data you are able to collect. So important to be mindful and have strategies
- For all interviews, regardless of format, as Woody Allen once said, it is absolutely crucial to ‘show up’ – be attentive, fully invested, and alert, get rid of the internal chatter beforehand and ensure you are not on autopilot (it happens…)Advantages/disadvantagesInterview FacilityParticipant Turf: Home, Place of work (e.g., medical practice)Spontaneous, without much reflectionUses flexible topic guide, open-ended, good for exploratory workRelies on building rapport, need to be sensitive to mood + non-verbal behavior
- Face to face allows you to use interpersonal, emotional and gestural cues to guide how + whether you ask certain questions – give examples herehttp://www.creducation.org/resources/nonverbal_communication/Daily Beast article on Chris Christie: normally demonstrative, quite quiet at press conference following fallouthttp://www.thedailybeast.com/articles/2014/01/10/christie-s-body-language-suggests-he-didn-t-believe-what-he-said.htmlBUT disadvantage is that we all ‘leak’ non-verbal information. This leakage can be helpful sometimes or it can disrupt what we are trying to achieve. NVB also important consideration because it is also laden with cultural baggage too – gender, age, ethnicity, social class or background – which can help or hinder. Examples?Examples of non-verbal leakage – ask for input first but refer to the following as dimensions of interpersonal communication that qualitative interviewers need to be attentive to:Facial expressionBody posture and gesturesAnimationVoice tone, pitch, inflection, and pace – even more important when using phone which we’ll talk about in a minuteEye contactSilence – let silence do the heavy liftingTo smile or not to smile?TouchSmellAppearance + personal presentation (eg professional? Casual? – depends on who is being interviewed, setting etc)Important to be sensitive to and tune into people’s NVB
- Resource packet from ESRCTelephonic: auto recording often an option with many conference call lines
- Online adds deeper level of interactivity to the interviews
- Make sure you build in different types of questions as we’ve discussed to get as full responses as possible